Wanted to ask you neuro nurses (& Canadian nurses) to maybe shed some light on the matter?
1) Does anyone know the treatment she received in Montreal? such as emergency surgery?
2) Her condition upon arrival? Did she arrive in time for emergency intervention or had she herniated at that point?
3) How does one go from walking off a bunny slope to brain dead in 24hrs or less? I could understand if there were circumstances that delayed her arrival to a hospital but it seems she got there in decent time?
Some patrollers are paramedics but some are volunteer first responders. I don't know if Mt. Tremblandt staffs with pro patrollers (medics) or not. Some places use a combination. I DO know that patrollers whether pro or volunteer are well-schooled in the care of patient's with suspected head injuries and are very good about explaining the risks of refusing care. I can only speculate but if the patroller was following usual and customary standards of care then those risks were explained and a waiver was signed. I'm not sure the medics on the ambulance would have been able to accomplish anything different nor am I sure that the staff on the ambulance were actually paramedics. They may function at the same level as a volunteer patroller. We'll never know what happened and I'm hesitant, without being party to the situation, to even hint at blaming anyone involved.
i haven't followed the specifics of her story, however i can tell you for working at montreal general hospital ( level 1 trauma center) ( mcgill university health center,a renown university and medical center) that they have an entire icu devoted to head traumas and a great team of researchers and neuro surgeons.the montreal general's counterpart for the university of montreal is the hôpital du sacré-coeur (where she was transported i believe), a major trauma center getting half of the major injuries occurring in the area as well as all the northern territories ([color=cyan]which are all transported by helicopter or private medical jet!)
if they were allowed to treat her, they would have been able to provide the very best care to her. if she was beyond the point on non-return, even the best neuro surgeon cannot reverse brain death!
not sure where you get your information, but here you go:
However, I feel it necessary to defend the Canadian response. No, I am not Canadian nor I have any close connections north of the border. All our AL listers should know that McGill University/Medical Center in Montreal is home to an absolutely stellar neuro program - among the best in the world. If they could not 'save' her, no one could.
Epidural bleeds are horrible. As a trauma ICU nurse, I have been on the receiving end of very few because they normally don't make it that far. We're talking less than an hour 's window for neurosurgical intervention. Every patient that I can recall was comatose with very little chance of meaningful recovery -- and they had surgery ASAP.
IMHO, it's a major design flaw - just like external male genitalia (LOL) - which may signal that our creator wasn't always on the ball when it comes to protecting sensitive and essential body parts. The temporal arteries lie just below one of the thinnest portions of the skull. Very vulnerable to even slight damage in that area. Because the bleed is arterial, it can rapidly compromise that area of the brain, cause massive tissue 'shift' - tearing and injuring brain tissue as it squashes against other surfaces of the skull. Even under the best circumstances when the injury tamponades itself, it causes a massive decrease in cerebral perfusion which then triggers a cascade of tissue necrosis. With all due respect to the medical professionals involved - I would imagine that her condition was beyond heroic measures when they transferred her 'home' to NY; so her family could be with her. It would have been the most compassionate thing to do.
In TBI, there is a phrase "talking and dying". I worked in a TBI unit for several years and this was something we saw frequently upon ER admission of a TBI--AAOX3, talking, ambulatory, many pts. even driving themselves to the ER. CT scan would show a bleed and IV steroids were started to prevent/reduce increased ICP, then evacuation of the hematoma was performed. A TBI doesn't require a hard hit, just the right kind of hit to cause damage. Even a light hit on the head can cause brain shearing (the impact causes the brain to bounce back hitting the skull, then bounce forward hitting the skull again) and this can bruise the tissue. This is particularly a risk in head impact which causes the neck to jerk. Helmets are designed to not only prevent the skull from being directly impacted, but also to absorb the shock of impact to prevent brain sheering.
FlyingScot was, I believe, trying to make the point that no matter how many EMS personnel were present, regardless of their advanced qualifications or lack thereof, this woman refused care and was reported to have signed a refusal of care waiver. So...no matter what the EMS responders knew about head injuries (and I'm sure they were well-educated in head trauma), they could do nothing to help Natasha Richardson because she wouldn't let them. So the only one to blame for her poor outcome was herself, unfortunately. Could she have survived had she allowed them to transport her for eval? Yes. And, she pobably would have had a full recovery without deficits. It wasn't the "fault" of Canada's lack of proximity to a head trauma center or the amount of time for transport. Her time had already run out. She refused care at the critical point--before the bleed caused irreversable damage. From the media reports, assuming they are accurate, it sounds like she developed a slow bleed. I think this case should prompt PSA's on television and radio as to the necessity of having a head injury assessed. It should be emphasized that just because you "feel fine" doesn't mean you ARE fine.
FlyingScot was, I believe, trying to make the point that no matter how many EMS personnel were present, regardless of their advanced qualifications or lack thereof, this woman refused care and was reported to have signed a refusal of care waiver. So...no matter what the EMS responders knew about head injuries (and I'm sure they were well-educated in head trauma), they could do nothing to help Natasha Richardson because she wouldn't let them. So the only one to blame for her poor outcome was herself, unfortunately. Could she have survived had she allowed them to transport her for eval? Yes. And, she pobably would have had a full recovery without deficits. It wasn't the "fault" of Canada's lack of proximity to a head trauma center or the amount of time for transport. Her time had already run out. She refused care at the critical point--before the bleed caused irreversable damage. From the media reports, assuming they are accurate, it sounds like she developed a slow bleed. I think this case should prompt PSA's on television and radio as to the necessity of having a head injury assessed. It should be emphasized that just because you "feel fine" doesn't mean you ARE fine.
Blaming the victim, how nice. The fact remains that Quebec does not have any type of air EMS. How absurd is that? Do you not get that they DROVE her to the local hospital then got back in the ambulance to DRIVE her to Montreal 2.5 hours away? Everyone is clear that she initially refused care but there is much else that ultimately contributed to her demise.
Specializes in Hospital, Foot Nurse, NRSNG Educator.
This has all been great information, and many things stated are so completely true , accurate and very educational, weather fact or personal comments. "WE" need to remember how things we read effect us, and it is all in the interpretation of the "state of mind of the reader", unfortunately, things said, can be terribly misunderstood. Yes we are all nurses here, no matter what form of nursing we work in, trained not to "judge". We need to be "thoughtful". It is certainly a sad thing, star or not, for the pt and family, when it is needless, or accidental death. Unless we were right there, we do not know all of the situation. Health Care is DYNAMIC, Everyone will learn from this, there is no choice in that .:heartbeat
I used to work NeuroTrauma ICU at a level 2 trauma center and SICU at a level 1.
I've never taken care of an epidural bleed. The one or two that were going to come to us that I remember died in the ER or OR.
What happened to Natasha Richardson was tragic. But a better EMS system probably wouldn't have saved her. She could have fallen walking into the ER of a level 1 trauma center and she probably would have died anyway.
There's no one to blame. She didn't think anything was wrong. No one could force her to seek medical care. Sadly, it was just her time.
I liked her movies. She and Liam Neeson seem like great people. I feel bad for her family. I'm glad they donated her organs. I hope it helps others make that decision if they are faced with it.
FlyingScot, RN
2,016 Posts
Some patrollers are paramedics but some are volunteer first responders. I don't know if Mt. Tremblandt staffs with pro patrollers (medics) or not. Some places use a combination. I DO know that patrollers whether pro or volunteer are well-schooled in the care of patient's with suspected head injuries and are very good about explaining the risks of refusing care. I can only speculate but if the patroller was following usual and customary standards of care then those risks were explained and a waiver was signed. I'm not sure the medics on the ambulance would have been able to accomplish anything different nor am I sure that the staff on the ambulance were actually paramedics. They may function at the same level as a volunteer patroller. We'll never know what happened and I'm hesitant, without being party to the situation, to even hint at blaming anyone involved.